Narcotics criteria

On my unit we have standard preprinted Labor and Delivery admission orders. We are running into an issue with our narcotics. Trying to stay up to date with JCAHO guidelines we have added a pain score to the orders, for example: Fentanyl 100mcgs IV every 2 hours for pain rating 5-10 using pain scale. However, as many of you labor nurses know, especially with primips, they rate there pain 10/10 frequently and they are remote from delivery. These orders dictate giving a short acting med instead of something that will last her longer like Demerol. But because the order for Demerol is for pain scale 1-4 we can't use it. So then you have to call the doctor and ask him if you can give the Demerol instead of Fentanyl. For some reason docs don't want a 3am call for that! My question is does anyone have any information about medicating laboring pts usings dilation rather than pain scale. It might be a dream but since nurses no longer can use there own judgment on pain medication ,I'm hoping someone has some info!